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2005, 03-29 Permit App: 05000960 Reroofrear it un uY: uUp OCT 19 2003 12:3? FR TO 5320893 SpolanTh alley P. 02/04 PERMJT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT BUILDING DIVISION 11707 East Sprague A ye Ste 106 Spokane Valley, WA 99206 Phone; 6091688-0036 Fax:15091688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL INSCRIPTION: PERMIT DESCRIPTION: /Lc C&UILDING PERMIT ❑ RELOCATION MANGE ZN USE C.GRADING CI SIGN TENANT C MANUFACTURED ,HOME OWNER / APPLICANT INFORMATION © OWNER; (' P-4 ❑ APPLICANT: PHONE: FAX: PHONE: FAX: ADDRESS: ADDRESS: CITY,STATE, ZIP CITY, STATE, ZIP °CONTRACTOR: 1-61-"V\-5 12•00 11 /\. ok Q ARCHITECT: PHONE:(C:\ )(, J 532 -L' T L FAX: ( S 00111 11 - c i3 PHONE: _FAX: ADDRESS: 1� F I 4(.4". L ADDRESS: / jCITY..ST/A�T�+E. ZIP p� . CITY, STATE, ZIP WA ST CONTRACTOR LICENSE 1 L{� 1 V/ L t 1C t_ r ire tl CONTACT:DT r PERMIT/BUILDING INFORMATION 0-P COST OF PROJECT: - Y9 � - / , Lt 30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 9UILDING HEIGHT TO PEAK: OCCUPANCY GROUP:. 2040 FLOOR SQ FT: BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNPIN BASEMENT: NUMBER OF STORIES:___ STRUCTURES ON PROPERTY: FINISHED BASEMENT: NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: DATE: I STAFF: METWOD OFPA YME7VT.•— — o o ❑ CASH CHECK EANKC R pti` REDACTED AUTHORIZED 3/G# TVR MAR 17 2005 16:16 EXPIRES' This document originally contained confidential credit card information which was redacted pursuant to RCW 19.255.010 and the original document destroyed pursuant to SOS DAN GS2014-MAGE. 02